Innovative Medicine of Kuban #4 (2018)

InnovativeMedicineofKuban #4(2018)

CONTENTS

Original articles

Issue of neurological complications risk after surgery for posttraumatic deformity of lumbar and thoracic spine

A.A. Afaunov 1, A.V. Kuzmenko 2, I.V. Basankin 2, M.Yu. Ageev 1

1 Kuban State Medical University, Krasnodar, Russia

2 Scientific Research Institute – Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia

Surgical correction and stabilization in post-traumatic spinal deformities is associated with the risk of neurological complications. However, at the present time, there are no prognostic scales for assessing the risk of neurological complications of surgical treatment of this category of patients.

Aim: to offer a rapid assessment system for the risk of neurological complications in the surgical treatment of patients with posttraumatic deformities of the thoracic and lumbar spine.

Materials and methodsThe results of treatment were analyzed in 124 patients with post-traumatic deformities of the thoracic and lumbar spine for the period 2003-2017. Among them, 70 men and 54 women aged from 18 to 54 years. Operations are performed in terms from 6 months to 14 years. since the injury. At the same time, in 61 cases of deformity development was the result of diagnostic errors and / or ineffective conservative treatment. 63 cases - were the result of unsuccessful surgical treatment

ResultsAnalysis of clinical material allowed us to identify 3 factors that determine the possibility of the occurrence of neurological complications of surgical treatment. These are the functional state of the spinal cord and roots in the late post-traumatic period, the spondylometric characteristic of the post-traumatic stenosis of the spinal canal and the localization of the deformity of the spinal column. For each of these factors, several gradations were suggested according to their degree of expression. All possible combinations of various gradations of three of these factors give a total of 46 estimated risk options for the development of neurological complications of surgical treatment of post-traumatic deformities of the thoracic and lumbar spine.

ConclusionThe proposed scale can be the basis for express assessment of the risk of neurological complications in the surgical treatment of patients with posttraumatic deformities of the thoracic and lumbar spine.

Key words: spine, complications, post-traumatic deformity, classification, neurological deficit, scale.

Author Credentials

Afaunov A.A., PhD, head of the traumatology and orthopaedics department and BFS, Kuban State Medical University (Krasnodar, Russia). E-mail: afaunovkr@

mail.ru.

Kuzmenko A.V., CMS, neurosurgeon,neurosurgery department #3,

Scientific Research Institutе - Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Basankin I.V., CMS, head of neurosurgery department #3, Scientific Research Institutе - Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Ageev M.Yu., assistant of the traumatology and orthopaedics department and BFS, Kuban State Medical University (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .



Clinical Researches

Platelet-rich plasma for persistent ulcers of the lower limbs

I.V. Gilevich, T.V. Fedorenko, E.A. Kolomyitseva, V.V. Fedushkin,

E.N. Shubrov, S.G. Slavinsky

Scientific Research Institute - Ochapovsky Regional Clinic Hospital #1, Krasnodar, Russia

Background Estimation of safety and efficiency of platelet-rich plasma in complex treatment in patients with persistent large ulcers.

Materials and methods Two clinical cases of patients with long persistent ulcers of the lower extremities that were administered local injections of the autologic platelet-rich plasma in the wound area in combination with or without autodermoplasty.

Results In the first case the patient had a trophic ulcer after erysipelatous inflammation without dynamics to healing in the setting of the carried treatment. Surgery was contraindicated due to severe accompanying pathology. This patient had 6 PRP courses (once a week). The regional epithelialization appeared on the 2nd week. After 6 injections full wound healing was noted. In the second case the patient had is a long persistent post-traumatic ulcer with 2% - square. The autodermoplasty with local introduction of PRP was performed. We observed a full graft acceptance on the 6th day.

Conclusion PRP use will allow to improve outcomes of treatment persistent ulcers of the lower extremities. It represents extremely important to continue work on PRP application due to an absence of complications and obvious contraindications in this method for carrying out comprehensive analysis.

Key words: platelet-rich plasma, long persistent ulcers of the lower limbs.

Author Credentials

Gilevich I.V., PhD, head of the laboratory for development and study of new treatment technologies, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Fedorenko T.V., biologist of the laboratory for development and study of new treatment technologies, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Kolomiytceva E.A., biologist of the laboratory for development and study of new treatment technologies, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Fedyushkin V.V., surgeon of the department of purulent surgery, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Shubrov E.N., surgeon of the department of purulent surgery, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Slavinskiy V.G., PhD, surgeon of the department of purulent surgery, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .



Case reports

Extracorporal cardiopulmonary resuscitation (ECPR) following pulmonary artery rupture in an infant

I.A. Kornilov, I.A. Soynov, A.V. Zubritsky, Y.Y. Kulyabin, S.M. Ivantsov, A.V. Gorbatykh, N.R. Nichay, A.Y. Omelchenko

Meshalkin National Medical Research Center, Novosibirsk, Russia

The rupture of the pulmonary artery during balloon valvular dilatation is rare and the severest complication. In this clinical case we described the rupture of the pulmonary artery in a 10-month-old baby with cardiac tamponada and an extreme hemodilution due to blood loss. CPR has been using for 40 minutes but being ineffective. For 3 days we have been applying ECMO. This patient was discharged without any neurological disorders.

Key words: ECMO, pulmonary artery rupture, balloon dilatation, extracorporal cardiopulmonary resuscitation, hemorrhage.

Author Credentials

Kornilov I.A., CMS, anesthesiologist- resuscitator, Department of Anesthesiology, senior staff scientist of the new surgical technologies center, Meshalkin National Medical Research Center (Novosibirsk, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Soynov I.A., CMS, cardiovascular surgeon, Department of Congenital Heart Disorders, senior staff scientist of the new surgical technologies center, Meshalkin National Medical Research Center (Novosibirsk, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Zubritsky A.V., CMS, cardiovascular surgeon, Department of Congenital Heart Disorders, junior staff scientist the new surgical technologies center, Meshalkin National Medical Research Center (Novosibirsk, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Kulyabin Y.Y., CMS, cardiovascular surgeon, Department of Congenital Heart Disorders, junior staff scientist the new surgical technologies center, Meshalkin National Medical Research Center (Novosibirsk, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Ivantsov S.M., CMS, cardiovascular surgeon, Department of Congenital Heart Disorders, staff scientist the new surgical technologies center, Meshalkin National Medical Research Center (Novosibirsk, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Gorbatykh A.V., CMS, cardiovascular surgeon, Department of Congenital Heart Disorders,junior staff scientist the new surgical technologies center, Meshalkin National Medical Research Center (Novosibirsk, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Nichay N.R., CMS, cardiovascular surgeon, Department of Congenital Heart Disorders, junior staff scientist the new surgical technologies center, Meshalkin National Medical Research Center (Novosibirsk, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Omelchenko A.Y., CMS, cardiovascular surgeon, Department of Congenital Heart Disorders, senior staff scientist of the new surgical technologies center, Meshalkin National Medical Research Center (Novosibirsk, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Endovascular treatment of thepatent ductus arteriosus

A.N. Pakholkov 1, E.S. Suslov 1, K.A. Lashevich 2, A.N. Fedorchenko 1,

V.A. Porhanov 1,2

1 Scientific Research Institution – Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia

2 Kuban State Medical University, Krasnodar, Russia

Correction of the patent ductus arteriosus (PDA) takes an important place in management of congenital heart defects (CHD). Untreated PDA can lead to heart failure due to left ventricular myocardial hypertrophy (LVH), pulmonary hypertension, bacterial endocarditis, pulmonary infection, and rarely the development of ductal wall aneurysm, its calcification and further rupture.

It is believed that the closure of PDA is indicated in any child or adult who develops pathognomonic symptoms: expansion of the left heart; the presence of signs of pulmonary hypertension with left-right blood discharge; previously transferred endocarditis. In asymptomatic patients with PDA accompanied by left ventricular hypertrophy closure of the duct is indicated to reduce the risk of further complications.

There were various surgical methods of PDA treatment discovered in the period of the development of medical industry. Previously the most common intervention was ligation of the duct, accompanied by thoracotomy. However, in the present days the ligation of PDA is extremely rare. Endovascular occlusion has taken the lead in the modern practice. Its purpose is to close the duct with intravascular access with help of specialised tools.

In this article we present a case of PDA management in a patient with clinical manifestation of PDA at the age of 35 years.

Key words: patent arterial duct, endovascular occlusion, intravascular access.



Author credentials

Pakholkov A.N., surgeon, x-ray diagnosis and treatment department, Scientific Research Institute - Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Suslov E.S., surgeon, x-ray diagnosis and treatment department, Scientific Research Institute - Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Lashevich K.A., Resident of department for cardiac surgery and cardiology department FAT, Kuban State Medical University (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .



Fedorchenko A.N., PhD, head of the x-ray endovascular diagnostics and treatment department, Scientific Research Institute - Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра.

Porhanov V.A., PhD, professor, academician of the RAS, chief doctor of Scientific Research Institutе - Ochapovsky Regional Clinic Hospital #1, head of the Department of Oncology with the course of thoracic surgery FPK and PPS, Kuban State Medical University (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра.

Donor Wound Treatment with Cell Technologies Application and Vacuum Therapy

A.V. Polyakov 1,2*, S.B. Bogdanov 1,2, D.N. Marchenko 1, I.V. Gilevich 1,2,

T.V. Fedorenko 1

Scientific Research Institution – Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia


We presented a clinical case of a patient treated for facial burns. We performed full thickness skin grafting taken from the abdominal surface. For treatment of abdominal wound we used dermal autologous fibroblasts, performed free skin grafting with split-skin grafts, and then placed a vacuum closure. A sufficient result was achieved.

Key words:skin grafting, dermal fibroblasts, vacuum therapy.

Author Credentials

Polyakov A.V., CMS, burn surgeon, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1, associated professor of general surgery department, Kuban State Medical University (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Bogdanov S.B., PhD, head of the burns center, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1, professor of the Department of Orthopedics, Traumatology and Military Field surgery, Kuban State Medical University (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Gilevich I.V., CMS, head of the laboratory for development and study of new treatment technologies, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1, teaching assistant of oncology department with course of thoracic surgery, Kuban State Medical University (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Fedorenko T.V., biologist of the laboratory for development and study of new treatment technologies, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

CLINICAL CASE OF THE YOUNG PATIENT WITH ISCHEMIC STROKE AND GENETICALLY CAUSED THROMBOPHILIC PREDISPOSITION

Y.A. Bursa, L.V. Timchenko, M.V. Kolodina

Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1, Krasnodar, Russia

We present a clinical case of an ischemic stroke in a young man, 37 years in the setting of severe cardiac pathology (coronary heart disease, repeated myocardial infarctions with a cardiomyopathy and progressing chronic heart failure).

This patient had an orthotopic heart transplantation. In a month we observed an intense violation of cerebral blood circulation, the diagnosis was established: an ischemic stroke in the right carotid pool with formation of the advanced area of ischemia in the right fronto- temporal and subcortical area. Total condition was complicated with cerebral edema and dislocation syndrome.

In the course of diagnostic search this patient demonstrated genetically caused thrombophilic predisposition in the form of gene- mutation of the blood coagulating factor – plasminogen activator inhibitor (PAI - 1), a glycoprotein Ia (ITAG 2 a heterozygote), F 7 heterozygote; the genetic polymorphism associated with violation of a folate cycle - MTHFR 1298 a heterozygote, the MTR heterozygote. The revealed mutations in heterozygous state genes with predisposition to thrombophilic complications can serve as a background for disorders in anti-coagulation and coagulation system which can appear at identification the factors starting the mechanism of its development. In a case with this patient, we speak about a secondary thrombophilia as a reason of an ischemic stroke in the setting of cardiac pathology, repeated myocardial infarctions, orthotopic heart transplantation, obesity. All above-mentioned factors allowed to administer reasonable pathogenetically justified antiagregant and anticoagulant therapy, folic acid drugs, group B vitamins for a purpose of secondary prevention of thrombotic complications.

Key words: ischemic stroke, orthotopic cardiac transplantation, genetically caused thrombophilic predisposition, gene-mutation.

Author credentials

Bursa Y.A., neurologist, head of the neurological department for patients with ACVE, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра.

Timchenkо L.V., neurologist, head of the neurological department for patients with ACVE, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Kolodina M.V., CMS, kardiologist of diagnostic center, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Reviews

Entotic sound: diagnostic parallels

E.V. Kolpakova, S.A. Zhade, E.A. Kurinnaya, V.V. Tkachev, G.G. Muzlaev

Scientific Research Institution – Ochapovsky Regional Clinic hospital #1, Cardiac surgery department #2, Krasnodar, Russia

We observed issues of etiology and pathogenesis, differentiatied diagnosis of enttic sound which is one of the frequent otoneurological complaints. Classification of this symptom is described.

Key words: tinnitus, somatosound, diagnostics.

Author Credentials

Kolpakova E.V., surdologist, otolaryngologist, diagnostic center, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Zhade S.A., MSC, neurologist, neurosurgery department 2, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Kurinnaya E.A., neurologist, head of diagnostic center, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Tkachev V.V., PhD, head of neurosurgery department 2, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Muzlaev G.G., PhD, professor, head of neurological diseases and neurosurgery AT department, Kuban State Medical University, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Orthostatic hypotension. Part 1: definition, classification, natural history

G.A. Golovina, O.N. Zhadan, K.A. Zargaryan, O.A. Kravchenko, N.E. Tripolskaya

Scientific Research Institute - Ochapovsky Regional Clinic Hospital #1, Krasnodar, Russia

Orthostatic hypotension (OH) is an excessive decrease of arterial blood pressure when one takes a vertical position. It represents violation of arterial blood pressure circulation at various states and is not an independent disease. OH is associated with an increased risk of the general mortality, incidence of myocardial infarction and cerebral stroke, falling and syncope. We describe definition, classification, prevalence and natural history of OH in this article.

Key words: orthostatic hypotension, syncope, orthostatic test.

Author credentials

G.A. Golovina, CMS, cardiologist, cardiology department #4,Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia).E-mail: //e.mail.ru/compose/?mailto=mailto% Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. " target="_blank"> Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Zhadan O.N., neurologist, head of the neurorehabilitation department, Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

K.A. Zargaryan, cardiologist, cardiology department #4,Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia).E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

O.A. Kravchenko, cardiologist, cardiology department #4,Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia).E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

N.E. Tripolskaya, cardiologist, cardiology department #4,Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1 (Krasnodar, Russia). E-mail: Этот адрес электронной почты защищен от спам-ботов. У вас должен быть включен JavaScript для просмотра. .

Scientific events chronicle

VII European School of Thoracic surgery

Paper abstracts, 2018